Colloid carcinoma of the minor duodenal papilla.

termittent epigastric pain and nausea. Her hemoglobin concentration was 10.3 g/dL. Abdominal imaging revealed a 4−cm cystic mass in the pancreatic head (l" Figure 1). ERCP showed an ulcerated polypoid mass at the minor duodenal pa− pilla (l" Figure 2). Cannulation of the nor− mal−appearing major papilla showed a dilated, 4−mm main pancreatic duct and a stricture of the main duct in the head of the gland (l" Figure 3). Cannulation through the mass showed contrast in the ectatic dorsal pancreatic duct, which con− firmed involvement of the minor papilla by tumor. Pancreas divisum was not pres− ent. A pancreaticoduodenectomy (Whip− ple procedure) revealed a polypoid gelati− nous mass measuring 3 ” 2 ” 1.5 cm pro− truding from the minor papilla. Histologi− cally the tumor showed mucin pools con− taining malignant epithelial cells (l" Fig− ure 4). Resection margins and 15 peripan− creatic lymph nodes were free of tumor. Despite an uncomplicated immediate postoperative course, CA 19± 9 levels are rising 22 months later along with possi− ble liver metastases. Tumors of the minor papilla are uncom− mon, but carcinoid tumors [1], somatos− tatinomas [2], and a case of a nonendo− crine ductal adenocarcinoma [3] have been reported. Reasons for the rarity of recorded tumors in this location may be a low incidence but also the lack of symp− toms caused by small indolent endocrine neoplasms and the absence of jaundice owing to patency of the major papilla [3]. Aggressive neoplasms may overgrow ad− jacent structures, thus obscuring their origin at the minor papilla [3]. Mucinous noncystic (colloid) carcinoma of the pan− creas represents only 1% ± 2% of all pan− creatic nonendocrine neoplasms [4,5] and has not been described in the minor papilla previously. It is characterized his− tologically by extracellular mucin lakes with “floating” malignant epithelial cells [4, 5]. It is important to distinguish colloid carcinoma from mucin−producing adeno− carcinoma, signet−ring cell carcinoma and mucinous cystic neoplasms because the prognosis of colloid carcinoma is sig− nificantly better than that of ordinary pancreatic ductal adenocarcinoma, with a 5−year survival rate of 57 % [4, 5].